| NPI | 1164626578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN77) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PR 9469) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2025-07-15 |